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25 February 2017, Volume 16 Issue 01 Previous Issue    Next Issue

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Effect of arsenic trioxide on EVI1 gene in regulating hematopoietic transcription factors in vitro ZHU Jianyi, LANG Wenjing, CHEN Fangyuan, XU Zhuoran, SHEN Lijing, ZHONG Jihua 2017, 16 (01):  42-47.  DOI: 10.16150/j.1671-2870.2017.01.009 Abstract ( 155 )   PDF (113KB) ( 47 )   Objective: To investigate the effect of arsenic trioxide (ATO) on EVI1 gene in regulating hematopoietic transcription factors in vitro. Methods: Acute myeloid leukemia cell line with high EVI1 gene expression-THP-1 cell line was chosen to study the relative mRNA expressions of EVI1 gene and hematopoietic transcription factors GATA1, GATA2, RUNX1, MPO, LMO2, CMYB, PU.1 and SCL by reverse transcription-real-time fluorescent quantitative polymerase chain reaction (RFQ-PCR) in vitro. Healthy adult peripheral blood mononuclear cells were used as controls. THP-1 cell line was then treated with ATO solution with concentrations of 1 μmol/L, 3 μmol/L, 5 μmol/L. Then the relative mRNA expressions of EVI1 gene and the above-mentioned hematopoietic transcription factors were re-determined by RFQ-PCR. Results: The expressions of GATA2 and CMYB increased in THP-1 cell line expressing high EVI1 gene, and the levels of GATA1, RUNX1, MPO, LMO2, PU.1 and SCL decreased in vitro. ATO had the ability to down-regulate EVI1 gene in a dose-dependent and time-dependent manner, and the in turn regulatory effect on other hematopoietic transcription factors was observed. Conclusions: THP-1 cells have an increased expression of GATA2 and then indirectly influencing other transcription factors to promote the proliferation of immature cells and inhibit the differentiation and maturation of myeloid and erythroid cells. ATO could specifically down-regulate the expression of EVI1 gene and decrease the activation of GATA2. References | Related Articles | Metrics

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Identification and antimicrobial susceptibility test of clinical oxidase-negative gram-negative bacilli with TDR-300B Plus automatic microbial analysis system WANG Su, ZHU Dedong, SUN Jingyong, HAN Lizhong 2017, 16 (01):  48-54.  DOI: 10.16150/j.1671-2870.2017.01.010 Abstract ( 174 )   PDF (694KB) ( 155 )   Objective: To evaluate the agreement between TDR-300B Plus automatic microbial analysis system and the existing clinical microbial analysis system for identification and antimicrobial susceptibility test of clinical oxidase-negative gram-negative bacilli (ONGNB). Methods: The TDR-300B Plus analysis system and matched Enterobacteriaceae ID&AST Kit were adopted to proceed identification and antimicrobial susceptibility test of ONGNB, and results of MALDI-TOF and VITEK 2 compact AST-GN13 were used as the controls. The Kappa value was calculated and McNemar test was performed to evaluate the agreement between TDR-300B Plus and controls. 16S rRNA sequencing was used as the final identification when there was an inconsistent result between TDR-300B and MALDI-TOF. The CLSI M07-A9 broth microdilution method was used as the final for antimicrobial susceptibility test when the susceptibility result of TDR -300B Pluswas obviously different from VITEK (S/R or R/S). Results: Identification of 209 strains of ONGNB showed that results of TDR-300B Plus had good consistency with those of the control method (Kappa values >0.90, and McNemar P values >0.05). Antimicrobial susceptibility tests showed that among the 14 antimicrobials, the complete agreement (CA) of 10 were above 90% apart from aztreonam （ATM）(86.02%), ceftazidime （CAZ）(85.79%), cefepime(FEP) (82.63%) and tigecycline(TGC) (82.76%). The almost agreement(AA) of all the antimicrobials were >90%. Except TGC (Kappa=0.704 8), the Kappa of the others were >0.80, with only 3 (ATM, CAZ and FEP ) having a McNemar P values <0.05. The total MD was 3.16%, and Escherichia coli (29/48) appeared to be the most. The most frequent type of MD was R/S/R(36/48) with CAZ and FEP the most common. The total very major disagreement(VMD) was 2.87%. The most frequent type of VMD was S/R/S (14/21), with meropenem(MEM) and sulphamethoxazole/trimethoprim(SXT) the most common. Conclusions: For identification and antimicrobial susceptibility test of ONGNB, results of TDR-300B Plus have high agreements with those of existing microbial analysis system, which can be served as a supplement and ensure routine clinical work smoothly. References | Related Articles | Metrics

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Expression of EGF-like domains of thrombomodulin domain 2(TM-D2) in Pichia pastoris LI Li, WANG Xiao, WANG Yao, KANG Jiang, ZHOU Luocheng, WANG Hairong 2017, 16 (01):  55-59.  DOI: 10.16150/j.1671-2870.2017.01.011 Abstract ( 96 )   PDF (1125KB) ( 47 )   Objective: To establish a Pichia yeast expression system expressing EGF-like domains of thrombomo-dulin domain 2(TM-D2) to obtain recombinant TM-D2 protein. Methods: The nucleotide sequence encoding TM-D2 was amplified by PCR before being ligated into pPICZaB vector. Then TM-D2-pPICZaB vector was constructed and confirmed by PCR and sequencing. After linearization, this recombinant vector was transformed into yeast GS115 by electric shock. Methanol was used to induce the expression of TM-D2, and the TM-D2 was identified by SDS-polyacrylamide gel electrophoresis and Western blotting. Results: Sequencing and PCR revealed that recombinant fragment of TM-D2 with his-tag was cloned into pPICZaB vector, and SDS-PAGE and Western blotting confirmed that TM-D2 protein was present in the supernatant. Conclusions: The recombinant vector TM-D2-pPICZaB is successfully constructed, and TM-D2 is well expressed in Pichia pastoris. References | Related Articles | Metrics

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Experimental study on effect of PIAS1 in regulating migration of macrophage and its mechanism WANG Weiyi, ZHANG Yongping, YUAN Yaozong, WU Yunlin, CHEN Ping 2017, 16 (01):  60-65.  DOI: 10.16150/j.1671-2870.2017.01.012 Abstract ( 208 )   PDF (832KB) ( 69 )   Objective: To investigate the effect of PIAS1 (protein inhibitor of activated STAT1) on regulating the migration of macrophage via transgenic zebrafish (Lyz-EGFP) with green fluorescent protein labelling macrophages, so as to provide evidences for basic research on anti-inflammatory role of PIAS1. Methods: Morpholino-PIAS1 (checking plasmid PIAS1 (213bp) GFP), PIAS1-mRNA (mRNA expressing plasmid PIAS1), and mismatch plasmid (as negative control) were established. The morpholino-PIAS1, PIAS1-mRNA, and mismatch plasmid were injected separately or together into zebrafish embryo using micro-injection method. When cultured for 6 h, the fluorescent protein expression was assessed under fluorescence microscopy to determine the efficiency and specificity of transfection. After cultured for 60 h, the tail of zebrafish was cut with a sterile scapel, and the migration and count of macrophages at the cutting site were observed by confocal microscope. The activation of ERK/JNK/p38MAPK/MMPs signal protein and MMP-9/TIMP-1 protein expression was detected by western blotting. Results: In single cell of 6 h embryo, the green fluorescence was reduced in morpholino-PIAS1 injected group, while no change was seen in mismatch control group. There was no significant difference in red fluo-rescence between these groups. And in the cutting tail of zebrafish, the migration of green fluorescent cells was increased in morpholino-PIAS1 injected group, mismatch control group and rescue group (morpholino-PIAS1+PIAS1-mRNA), while it was reduced in PIAS1-mRNA injected group, the difference was statistically significant(P<0.05). Western blotting showed that the phosphorylation levels of ERK/JNK/p38MAPK proteins and the ratio of MMP-9/TIMP1 proteins were increased in morpholino-PIAS1 injected group, mismatch control group and the rescue group, while were decreased in the PIAS1-mRNA injected group(P<0.05). Conclusions: PIAS1 is an inhibitor for macrophage activation, and is involved in ERK/JNK/p38MAPK/MMPs signaling transduction pathways. The up-regulation of PIAS1 expression could inhibit activation of macrophage and to ameliorate the severity of inflammatory diseases. References | Related Articles | Metrics

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Primary non-myxomatous cardiac tumor: clinicopathologic analysis of 19 cases CHEN Xiaoyan, WANG Chaofu, DONG Lei, XU Haimin, JIN Xiaolong 2017, 16 (01):  66-72.  DOI: 10.16150/j.1671-2870.2017.01.013 Abstract ( 75 )   PDF (1496KB) ( 121 )   Objective: To investigate the clinicopathologic and diagnostic features of non-myxomatous cardiac tumors for improving the diagnostic level of the disease. Methods: Nineteen patients with pathologically confirmed primary non-myxomatous cardiac tumor during January 2009 to July 2016 at Ruijin Hospital were enrolled in this study. The clinical and pathologic features, imaging findings and immunophenotype of these cases were analyzed retrospectively and relevant literatures were reviewed. Results: Nine of the 19 cases were benign tumor (9/19), including 3 hemangioma, 3 lipoma, 2 papillary fibroelastoma and 1 schwannoma. Eight cases were malignant tumors (8/19), including 5 angiosarcoma, 1 malignant mesothelioma, 1 synovial sarcoma and 1 diffuse large B cell lymphoma.Two cases were intermediate tumors (2/19), including 1 fibromatosis and 1 composite hemangioendothelioma. Clinically, most of the patients presented with recurrent chest tightness and dyspnea. In patients with benign tumor, symptoms was mild or even absent and some patients were discovered during routine physical examination. Serious symptoms were seen in patients with malignant tumor. Conclusions: Primary cardiac non-myxomatous tumors are extremely rare,consisting various types of tumors and lacking specific clinical manifestations. The diagnosis of benign tumor is relatively easier. The malignant tumors are mainly sarcoma,especially angiosarcoma. Other types of malignant tumors are rare and their histomorphology are of diversive state; the definite diagnosis depends on histopathology and immunohistochemical examination and molecular detection. References | Related Articles | Metrics

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Expression and analysis of HIC-1 and HMMR in breast cancer WU Yan, DING Peifen, GU Yan, GUO Shanyu, DAI Qiancheng, ZHANG Wei 2017, 16 (01):  73-78.  DOI: 10.16150/j.1671-2870.2017.01.014 Abstract ( 142 )   PDF (978KB) ( 30 )   Objective: To study the expression of tumor suppressor gene hypermethylated in cancer 1(HIC-1)and oncogene hyaluronan-mediated motility receptor (HMMR) in lobular hyperplasia of mammary gland, breast fibroadenoma and breast cancer, as well as their relationship with the clinicopathological parameters of breast cancer. Methods: Expressions of HIC-1 and HMMR was examined by immunohistochemistry on 57 resected tissue samples taken at breast surgery: lobular hyperplasia 17 cases, fibroadenoma 20 cases and breast cancer 20 cases. The staining results were assessed semi-quantitatively, and were analyzed with the clinicopathological parameters of breast cancer. Results: ① HIC-1 was mo-derately positive in lobular hyperplasia and fibroadenoma tissue (average score 5.65), and was weakly positive in breast cancer tissue(average score 2.15). The difference in expression of HIC-1 between mammary benign lesions and breast cancer was significant (P<0.001). ② Expression of HMMR in mammary benign lesions was low (average score of fibroadenoma was 0.3, average score of lobular hyperplasia was 0), while the expression of HMMR in breast cancer was with an average score of 2.3 (P<0.001). ③ No obvious correlation was observed between protein expression of HIC-1 and HMMR and cli-nicopathological parameters of breast cancer. Conclusions: Expression of tumor suppression gene HIC-1 is significantly low and oncogene HMMR is relatively high in breast cancer. HIC-1 and the downstream gene HMMR regulated by HIC-1 may be involved in the development and progress of breast cancer. References | Related Articles | Metrics

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Comparison of immunohistochemistry and immunofluorescence in renal core biopsy specimen JIN Jingjing, XIAO Li, GU Yan, YIN Yulei 2017, 16 (01):  79-83.  DOI: 10.16150/j.1671-2870.2017.01.015 Abstract ( 254 )   PDF (1000KB) ( 310 )   Objective: To study the feasibility of detecting abnormal immune complex in paraffin section of renal core biopsy specimen by immunohistochemical method. Methods: Thirty-six core biopsy specimens of kidney with glomerular nephritis were examined by frozen section immunofluorescence and paraffin section immunohistochemistry to evaluate the results of immunohistochemical detection in reference with the that of immunofluorescence. Results: For the 7 cases of lupus nephritis, 16 cases of IgA nephropathy, 13 cases of membranous glomerular nephritis, immunohistochemical staining of IgA, IgG, IgM and C1q, C3c, C4c were in concordant with those of immunofluorescence both in expression intensity and location. Conclusions: Immunohistochemical examination of paraffin section after appropriate antigen retrieval can be used as a complementary method for the unsatisfactory result of immunofluorescence detection in frozen section. References | Related Articles | Metrics

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Diagnostic value of IELISA for human Brucella infection HE Jingjing, LIU Jingyao, ZHANG Yan, ZHAO Dongmei, ZHENG Zunrong 2017, 16 (01):  84-87.  DOI: 10.16150/j.1671-2870.2017.01.016 Abstract ( 146 )   PDF (454KB) ( 64 )   Objective: To investigate the diagnostic value of indirect enzyme-linked immunosorbent assay (IELISA) for human Brucella infection. Methods: A total of 116 patients with confirmed Brucella infection were enrolled, and 66 suspected cases and 72 healthy subjects were served as controls. Venous blood was collected to detect Brucella antibody by standard tube agglutination test (SAT), IELISA, Rose-Bengal plate agglutination test（RBPT) and blood culture was performed for isolation of Brucella bacteria. Result of SAT test was taken as the golden standard, and the diagnostic value of IELISA, RBPT and blood culture were analyzed. Result: Positive rates of SAT, IELISA, RBPT and blood culture in confirmed acute (100%, 98.6%, 91.3%, 20.3%) and chronic Brucella infection patients (100%, 97.9%, 91.5%, 10.6%) were significantly higher than those in suspected patients (0, 6.0%, 0, 0, all P<0.05) and healthy controls (1.4%, 0, 2.8%, all P<0.01; blood culture not done). The IELISA was in good agreement with SAT and RBPT (Kappa=0.846, 0.966). The sensitivity (98.3%) and specificity (100%) of IELISA were the highest . Sensitivity and specificity of RBPT were 91.4% and 97.2%, respectively. Conclusions: Compared with RBPT and blood culture, IELISA has a better diagnostic accuracy for Brucella infection, and is more convenient and rapid. References | Related Articles | Metrics

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A study on correlation between multiple sclerosis and Epstein-Barr virus and IL-17/IL-23 MENG Jun, PENG Yibing, WANG Xuefeng, CHEN Ninan, ZHANG Dongqing 2017, 16 (01):  88-92.  DOI: 10.16150/j.1671-2870.2017.01.017 Abstract ( 173 )   PDF (575KB) ( 92 )   Objective: To study the expression of Epstein-Barr virus (EBV) autoantibodies and IL-17, IL-23 in cerebrospinal fluid of patients with multiple sclerosis (MS) and to define the relationship between IL-17/IL-23 and pathogenesis of MS for hoping to provide a diagnostic reference for clinical practice. Methods: Seventy-two patients with neurological diseases in Ruijin Hospital were categorized into 2 groups: 29 cases with central nervous system autoimmune disease (study group) and 43 cases of non-central nervous system autoimmune disease (control group). Enzyme-linked immunosorbent assay (ELISA) was used to assess the levels of EBV-VCA-IgM, EBV-EBNA-1IgG, IL-17, IL-23 in CSF. Results: The expressions of EBV-EBNA-1IgG, EBV-VCA IgM and IL-23 in study group were significantly higher than those in control group (P<0.01). In study group, the expression of IL-23 in MS patients was significantly higher than that in control group（P<0.01), and the expression of IL-17 in MS patients was higher than that in control group（P<0.05）. Conclusions: EBV is related to MS and probably contributes to the pathogenesis of MS. Meanwhile, the abnormal inflammatory axis of IL-17/IL-23 may also be related to the induction of MS. The study indicates a relationship of MS not only with viral infection, but also with a disordered autoimmune system. References | Related Articles | Metrics

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Establishment of urinary micro-RNA detection method and its application in diagnosis of bladder cancer LI Li, BIAN Bingxian, ZHANG Liang, SHEN Lisong 2017, 16 (01):  93-97.  DOI: 10.16150/j.1671-2870.2017.01.018 Abstract ( 173 )   PDF (680KB) ( 65 )   Objective: To establish a method for detection of 8 urinary micro-RNA and to detect their distribution in urine and evaluating its significance in detection of bladder cancer. Methods: Early morning and random urine samples from 15 healthy controls and random urine samples from 15 patients with bladder cancer were collected. The total RNA were extracted and then were reversely transcripted to cDNA, and 8 micro-RNAs (miR-126, miR-200a, miR-200b, miR-200c, miR-182, miR-183, miR-429 and miR-141) were amplified with real-time polymerase chain reaction (PCR). Diffe-rences in miRNA levels were compared between early morning and random urine samples as well as between non-concentrated and concentrated samples. Different extraction and purification methods for miRNAs were compared and the diffe-rences of miRNA concentrations between controls and bladder cancer patients were analyzed. The diagnostic efficacy of multiple urinary miRNA combinations for bladder cancer was analyzed using ROC curve. Results: The relative concentrations of 6 miRNAs (miR-126, miR-200a, miR-200b, miR-200c, miR-429 and miR-141) were significantly higher in the concentrated urine than those in non-concentrated urine. There was no significant difference in relative miRNA concentration between early morning and randomized urine collection. Compared with normal controls, the relative concentrations of 4 miRNAs (miR-126, miR-182, miR-183 and miR-141) were significantly increased in bladder cancer group while miRNA-200a was significantly decreased. ROC analysis showed that detection of single miRNA had limited diagnostic efficacy for bladder cancer, while combined analysis of 5 miRNA had better diagnostic value for bladder cancer. Conclusions: Multiple micro-RNAs are stably distributed in urine, and combined detection of multiple miRNAs might be used as a dia-gnostic marker for bladder cancer. References | Related Articles | Metrics

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Correlation of plasma miRNAs levels with atrial fibrillation in patients with acute cerebral infarction in early stage HU Rongguo, PANG Defang, HUANG Shu, SHEN Zhenkun, CHEN Wei, YANG Yuwei, LAI Xiaoyin, ZHU Wei, WU Feifei, JI Haifeng, WU Dayu, JIANG Mei, SUN Jialan, LI Longxuan 2017, 16 (01):  98-103.  DOI: 10.16150/j.1671-2870.2017.01.019 Abstract ( 113 )   PDF (638KB) ( 28 )   Objective: To investigate the correlation between the plasma miRNAs levels and atrial fibrillation (AF) in patients with acute cerebral infarction in early stage. Methods: Seven hundred and one patients with acute cerebral infraction addmitted in Gongli Hospital during Jan. 2014 to Nov. 2016 were enrolled, and patients were divided into two groups: group with AF(70 cases) and group without AF (631 cases), and 65 healthy cases were served as controls. Clinical data and miRNAs levels between the 3 groups were analyzed, and miRNAs levels were also compared between paroxysmal and persistent AF. Multivariate regression analysis was used to determine the contribution of plasma miRNAs variables to the presence of atrial fibrillation in patients with cerebral infarction in early stage. Results: Plasma levels of miR-328, miR-29b and miR-150 differed significantly between group with AF, group without AF and control group (P<0.05, P<0.01). Different from miR-328 and miR-150, plasma level of miR-29b in cerebral infarction patients with paroxysmal AF was significantly lower than those in group without AF and controls (P<0.01). Logistic regression analysis showed that the specific miRNAs, miR-328, miR-29b and miR-150 were significantly associated with AF and miR-29b was significantly related to paroxysmal AF in patients with acute cerebral infarction. Conclusions: Levels of some specific plasma miRNAs, especially the miR-29b level might be used as predictor for the existing of AF in patients with acute cerebral infraction in early stage. References | Related Articles | Metrics

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Application of sinogram-affirmed iterative reconstruction technique in low-dose lung CT screening WU Meng xiong, CAO Qiqi, YANG Wenjie, YAN Fuhua, YAN Ling 2017, 16 (01):  104-108.  DOI: 10.16150/j.1671-2870.2017.01.020 Abstract ( 167 )   PDF (820KB) ( 59 )   Objective: To compare the performance difference on image quality between sinogram-affirmed iterative reconstruction (SAFIRE) and filtered back projection （FBP）in low-dose lung CT screening. Methods: A total of 304 patients receiving annual low-dose lung CT screening were examined by a dual-source CT system at 120 kV with reference tube current of 40 mA·s. Six image serials were reconstructed, including one dataset of FBP and five datasets of SAFIRE with different reconstruction strengths from 1 to 5 (S1 to S5). Image noise and subjective scores of image noise were recorded. Images artifacts and overall image quality were also assessed by two radiologists. Results: The mean weight and the body mass index of patients were （66.3±12.8） kg and 23.4±3.2, respectively. The mean dose-length product was (95.2±30.6） mGy·cm, and the effective dose was （1.6±0.5） mSv. The observation agreement for image noise grade, artifact grade and the overall image quality was in good consistency (r=0.785, 0.595 and 0.512). Among the overall six datasets, both the scores of measured mean objective image noise and the subjective image noise of FBP were the highest, and the image noise decreased with the increasing of SAFIRE reconstruction strength. The datasets of S3 obtained were the highest quality scores for image. Conclusions: Compared with FBP, SAFIRE reconstruction may significantly improve image quality in low-dose lung CT screening and SAFIRE with reconstruction strength 3 is a pertinent choice for low-dose lung CT. References | Related Articles | Metrics

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Misdiagnosis of low position intestinal tumors in women by ultrasonography JIANG Meijiao, ZHAN Weiwei, CHEN Hui, XU Ruiyun, YANG Zhifang, LIU juan 2017, 16 (01):  109-113.  DOI: 10.16150/j.1671-2870.2017.01.021 Abstract ( 118 )   PDF (771KB) ( 140 )   Objective: To analyze the causes of ultrasound misdiagnosis of low position intestinal tumor in female patients for improving the preoperative diagnosis. Method: To review and analyze eighteen women with surgically and pathologically proved low position intestinal tumor who had been misdiagnosed as gynecologic tumor preoperatively by ultrasonography between 2008 and 2015.The causes of misdiagnosis were analyzed. Result: Imaging of preoperative ultrasonography denoted as gynecological tumor in 12 cases and did not reveal the source in other 6 cases. The mass was of cystic and solid echo in fifteen cases, hypoechoic in two cases, and anechoic in one case. Operative exploration revealed that the mass was from small intestine in all the cases and hence resection of the small intestine tumor was conducted. Pathological findings showed that 16 cases were small intestinal stromal tumor, one was small intestinal leiomyoma and one was intestinal deformity. Conclusions: Low position intestinal tumor in women are often misdiagnosed as uterine appendage tumor. Ultrasound is a preferred approach of examination, and special focus should be paid on the identification of blood supply and the relationship between the tumor and uterine appendage. References | Related Articles | Metrics

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Analysis of causes of upper gastrointestinal bleeding in portal hypertension patients with varicosity at different positions of esophageal and gastric fundus vein ZHU Bingliang, SHA Jie 2017, 16 (01):  114-117.  DOI: 10.16150/j.1671-2870.2017.01.022 Abstract ( 131 )   PDF (502KB) ( 29 )   Objective: To analyze the causes of upper gastrointestinal bleeding in patients with portal hypertension for investigating the relationship between varicosity at different positions of esophageal and gastric fundus vein and the causes of bleeding. Methods: One hundred and twenty-one patients with portal hypertension and upper gastrointestinal bleeding were divided into three groups according to the variceal position: esophageal varices group(varicose vein only seen in the esophagus, n=40), gastroesophageal varices group (varicose vein in both esophagus and stomach, n=48), gastric varices group (varicose vein only in the stomach, n=33). Stochasticly selected cases in each group were analyzed differentially for the cause of variceal bleeding. Results: The top three bleeding causes in esophageal varices group were variceal rupture bleeding (80.0%, 32/40), peptic ulcer bleeding（10.0%, 4/40）and portal hypertensive gastropathy and other causes (all were 5%, 2/40); in gastroesophageal varices group were variceal rupture bleeding (83.3%, 40/48),peptic ulcer bleeding (8.3%, 4/48) and portal hypertensive gastropathy (6.3%, 3/48); in gastric varices group were peptic ulcer bleeding (54.5%, 18/33), variceal rupture bleeding(18.2%, 6/33), and other causes(15.2%, 5/33). The incidences of variceal rupture bleeding as the cause of bleeding in esophageal varices group and gastroesophageal varices group were significantly higher than that in gastric varices group （P<0.001）. Conclusions: Portal hypertensive patients with varicosity at different positions may have different causes of upper gastrointestinal bleeding. The position of variceal veins has a guiding significance for differetia-ting the cause of upper gastrointestinal bleeding in such patients. References | Related Articles | Metrics